Flexible Fitness: When concussion symptoms don't go away

Thursday

Jul 17, 2014 at 4:17 PMJul 17, 2014 at 4:17 PM

By Danielle Morgan-StevensonDaily News correspondent

Every year there are millions of brain injuries due to head trauma, with 1.6 million to 3.8 million associated with sports and recreation every year in the U.S. This number includes concussions, which are considered to be a mild form of Traumatic Brain Injury (TBI). ER visits for concussion increased 57 percent from 2001 to 2009. These injuries are occurring in sports, leisure activities, accidents on the road and at work.What is concussion? How would you know if it happened to you?CDC defines it as a "mild brain injury caused by a bump, blow or jolt to the head or body." The brain is jolted around inside the skull. A person with concussion is not necessarily "hit" on the head and they may not lose consciousness.The symptoms of concussion are many. A person with concussion may have some or all of these symptoms: slow to take in information (listening or reading), trouble concentrating and poor short-term memory which emerges after the injury, headache, fatigue, sleep disturbance, dizziness (caused by disturbance of the "balance system" in the inner ear), tinnitus (ringing in the ears), oversensitivity to light and sound, as well as psychological symptoms of anxiety, depression or irritability. Depending on the circumstances at the time of injury, some people also sustain Post Traumatic Stress Disorder (PTSD).A visit to the ER or to your doctor is recommended with these symptoms. The doctor’s advice will probably be "take it easy." Sometimes it may be necessary to take a break from work. Typically the symptoms will resolve in approximately two to three weeks.However, in some cases, symptoms persist for weeks, months or even longer. Post Concussion Syndrome (PCS) is diagnosed when symptoms are present for three months or more. The reasons why some people have PCS are complex, and it is thought to result from a combination of physiological and psychological symptoms before/during and after the injury.It is estimated that 15 percent of people with one concussion may develop PCS. Children and adolescents take longer to recover from concussion, according to the Center for Disease Control.Treatment for PCS requires a team of specialists consisting of doctors and therapists.One of the specialists to treat concussion may be a speech language pathologist (or speech therapist) who specializes in cognitive rehabilitation, that is, therapy to assess and treat problems in attention, memory or high level reasoning. The speech therapist’s goal is to help the patient regain or approach their former level of cognitive function before the concussion.There are different approaches to cognitive rehab. One approach is threefold: first, the "coaching stage," second, gradually increasing cognitive challenges and third, transition back into job and/or studies."Coaching" requires an individualized program with the concussed person learning to self-monitor their symptoms and know their limits. The therapist helps the person stay within those limits using a variety of strategies and keen attention to pacing the activity level.The "challenge" period begins after significant mental and physical rest with pacing when the symptoms are largely eliminated. Using knowledge of that person’s cognitive strengths and weaknesses, the therapist carefully increases the complexity and cognitive demand. For example, the therapist will challenge the individual by gradually increasing the level of distraction or processing speed, increasing the memory load or requiring multitasking. Care is taken to avoid escalating the symptoms while increasing complexity. The concussed person and therapist "feel the way forward" until it is clear the mental endurance and consistency of cognitive functioning is improving. The third stage can then begin as the recovering person gets help transitioning into work/school. Communication with employer or school faculty is important to support the transition. Maintenance of some strategies may continue in those environments.As progress continues, the individual can proceed without a therapist, managing the daily cognitive load while the effects of concussion diminish entirely.In this manner, an individual can progress gradually from debilitating symptoms into former work/life routines.Danielle Morgan-Stevenson, MS CCC LCST, is a speech therapist with 31 years of experience in cognitive rehabilitation who works at Spaulding Outpatient Centers in Framingham and Cambridge.